Healthcare Provider Details

I. General information

NPI: 1356847198
Provider Name (Legal Business Name): KIMBERLY DEPPISCH DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KIMBERLY HAMMERNIK

II. Dates (important events)

Enumeration Date: 04/02/2018
Last Update Date: 05/27/2024
Certification Date: 05/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 E HOLLAND AVE STE 101
SPOKANE WA
99218-1246
US

IV. Provider business mailing address

PO BOX 5299 MS: 820-5-PCO
TACOMA WA
98415-0299
US

V. Phone/Fax

Practice location:
  • Phone: 509-342-3010
  • Fax: 509-755-5376
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number58.030193
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOP61164059
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: